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Home My WebLink AboutAUTUMN RIDGE LT 21Autumn Ridge Lot 21 #015-054-24 Municipality of Anchorage Page 1 of 3 Development Services Department onSde Water and Wastewater Program 4700 South Bragsw Street P.O. Banc 196650 Anchorage, AK 995196650 wWw.ai.enthorage.ek.us (9071343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 5=12443 PID Number. 015-054-24 n.aa: Wastewater System: New Crown Pointe Inc. A,W••• ABSORPTION FIELD 5400 Abbott Road Anch. AK 99507 Peau weera ^• Deep Trench 345-6277 Five 5 Sad R.uq. Taal Doge baro anD.W vaw. LEGAL DESCRIPTION .7 craFP 12 Ft. BatuLa 6Wervanrc D.Whb P"DDaan hen a�PW V•e•' Cava EaDFl Dansae�pp'. 8 Fi 21 Autumn Ride 4 Ft. Towiwr.p� aaga. asGh.e Ful aeew aEaw aq'�W prtl.. Crave LsnpR 70 1 Fn. Fn. cr.rsi w.m[ nw,Rer a rr.: u.Wv Dawe«, rr.: Well: New 3 Fc. 1 Ft Cwsr� iPmaa, A 0. ck Tow pwm: Cassa b'. 60 TOW asap", nw Pp nAerarW. 1.120 F� ASTM D3034 PVC Private 64 n. Fl Deur. Das Dnssa sw¢We Uva-. .*WW Dau.»c sanders & 5andere 11/8/2002 AI ine Drillin 11/10/2002 36 Fr n.n Punpsaa c...v •Craw TANK 10 Ci I F 2 FI SEPARATION DISTANCES 0 septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lit Holding wwPdvme Lwja ,,, 1.500 Anchorage Tank From Tank Fceid station Tank sewerune Mama. nh,aer a Lanp�anan Wait >10a >100' N/A N/A >25' steel Two 2 LIFT STATION — NONE ON LOT &rlra war >109 >109 N/A N/A tat. - aCi1IM: Lava >9 AU N/A N/A ca 'PunD an level a 'PunD aH' Isva a /lqh war aero a. Foe i,xl >5 A(y N/A N/A im n yr -7-V-1 puDpMau aMoes EINmr "Pdtcpa WMttWW Cutin Dlan None Noted F7 Rana.F BENCH MARK Loulanw Der+Won- Dack Door Stoop Southwest Side. /unanee EMvaiae 100.0 FL Engineer's Stamp d �i Inspections perfomvd by. MFA Dates: 1a 11/8 02 49 h•�4 S 2na III&LO2 • 32, 00, A UIC �R C. •ANDERSON Department of Health and Human Services approval .,as'f ria. CE -4381 Reviewed and approved by: Date:.6:2?-O 3 �a O P� •• h�� E55t .•• law. nowt w o, .YLT9 3.60.OZ.[0 S m 4Sy11.1 WS3 '3 V '1 .01 Z �0L F® v CD n N Z r p � N ? W 170l� O UJO W C Er d 0 N 0 Z q'U K DO0 'm0, vN Zc>' m y 3 u o 0 W CD to C wit N N 3 m m o � JJ o® i O D O co 0 Ln CD cn ,(1 z •�', _0 0 _ En _ _Qj! % ♦ : 0 i O r R O14GN+ 'CD c& /? f. S {O0 GAGA D O �I I•hL � A 1 / I 4 N f P N r � G O N m •� ''•.. Y •''• �1 O A N Ol v z 10' T. & E. ESMT. o p N 0908'59'W 116.34' m tuk N � A W N O —w W Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519.6655 - 343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit Number..SW020226 IACKitLL Page 3 of 3 PID No. 015-271-62 0 N U f= S U 70' Trench Length - tti PROFILE AS -BUILT "` NEO. CE -4381 RS°; Scale: 1' • 10' .._. •'.01 FROM : ALPINE DRILLING FAX No. : 907 345 0202 Jan. 09 2003 09:44AM P2 Municipality of Anchorage Department of Health and Human Services 825'L' Street P.O. Box 196650 Anchorage. Alaska 99519-6650 Rick Myst hm:rnw.w.U.anchorage.at.Us ' Mayor Permit Number. #SW 020443 Date of Issue: 10-31-0 Parcel ldentifevfioe; Nuiobcr: 015-054-24 Date Started: 11-10-02 Date Completed: 1-1 is well located at approved permit location? 0 Yes Ll No Legal Des-miption: Autumn Ridge Lot 21 Psoperty'Owner Name & Address: POO n fti to l c. Borehok Data: Depth (ft) hlatl+od of Drilling ® air rotary ❑ cable tool ;oil Type, Thiclmest3 WaWSUAa From To Casing type -.&el stick-up 0 2 Wall Thicicncss:.250 inches 2 4 Diameter: g inches Deptb: 60 feet DfgBRlCS & Sit 48 LinerTypc grdvemysflt 4 putt inches Dep$1 12'to 14 'feet Sift 48 52 Casing stickup above ground: -2 feet gravelly silt 52 55 Sft c water level (frvat Pound level): Xfcet silty mfer send d gravel 55 58 ruzup;eg level 55 feet after gravelly aft 58 64 2 hours pumping. 10 Spin Remi -try Raw.. 10 em. t+4ahW of Testing: air M Well Intake opening Type: 0 {fit mad D open Holc I] Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet (;rest Type: hentontre M Volume: Lbz Depth: Start p feet Stopped y feet Pump: IntakeDcpth feet p=p size hp Brand Name Wen Disinfected Upon Complciion? ® Yes ❑ No ;Nltfaod of Dbinfcctiow ddorine tablets Cummeats: Well Driger: A0w Dn'#kV & Enterprises PO Box 110496 Anchorage Alaska 99511 Attcatioo: The well driller shalt provxle a wtlt log to the properly owner within 30 dais of completion WA the property I(- 6-0z- 02 MUNICIPALITY OF ANCHORAGE Development Services Department On-SiteWater& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Oct 31, 2002 Expiration Date: Oct 31, 2003 Permit Number: SW020443 Parcel ID: 015-054-24 Legal Description: AUTUMN RIDGE LT 21 Design Engineer: 0014 Anderson Engineering Site Address: Owner Name: Crown Pointe, Inc. Lot Size: 40377 SO. FT. Owner Address: PO Box 112313 Total Bedrooms: 5 Permit Bedrooms: 5 Anchorage . AK 99511 - This permit is for the construction of: 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 11 -V -o2_ Date: 10131107, Municipality of Anchorage Development Services Department _Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. D15'-1)541-.9 Permit Number SW020443 Property owner(s) Crown Pointe, Inc. Day phone 345-6277 Mailing address (1) P.O. Box 112313 Anchorage AK 99511 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 21 Autumn Ridge Subdivision Legal description (Section, Township & Range) Lot Size 40,377 SF Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Five (5) Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: S'S 0 Z' I Waiver Fees: Date of Payment: /0-Z f - 0 L Date of Payment: Receipt Number: Z74/3 e 1 Receipt Number: (Rev. 12100) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) October 28, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 21, Autumn Ridge Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 21, Autumn Ridge Subdivision intends to construct a new five - bedroom home on the property. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the new well and septic system and the parameters used In the design. Also identified on the plans are the alternate site, test hole locations and wells and septic systems on the surrounding lots. Drainage arrows are also shown and current drainage patterns will be maintained after construction. The test holes placed near the location of the proposed absorption trench and alternate site indicated gravel with sand and some silt. The percolation rate on the material was measured at 6 to 35 minutes per inch. No ground water was found and none was noted during the recent high water period. We are therefore proposing to place a new 1,500 -gallon septic tank with a new 70' long absorption trench with 8' of gravel beneath the distribution pipe. The total depth of the trench will be 11' below the surface with the distribution pipe at 3' below the surface. We have used an application rate of .7 to design the absorption trench as an average for materials expected to be encountered in the trench. An adjustment will be made in the field if soils are not consistent with our assumption. The ground surface on the lot slopes at varying grades from east to west. The absorption trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. All components of the new septic system will be constructed a minimum of 100' from the wells in the area. The system will also be constructed a minimum of 1 00'from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: Lot 21, Autumn Ridge Subdivision October 28, 2002 Page Two The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, ma''t e- �, Michael E. Anderson, P.E. Attachments U WC.AEL C. ANDERSON No. CE -438' •`_� 4W) �10� � CA�LMG� 404.9 , + ,r + �,_•_ � I45.474/ ft. 5 I ,- 40.381-sq.ft j T14-12 i 40.196 s ft. r" I IH 40.516 ft` J f/ 40.4 sq% \ 40.167 sq.f`tl \ o kft. \ o./\i BANDON i RIVE WAY W �% rth8• �9 \\,IH v _ft. •�-- �C•--•-tet \TI � � `"4— �54.849\sq ft _ \ Th �J �1J IH -3 Q -\ ,\ ,45,Mr—sq f % \ 49th -32 , �•/`��,�, �.\�� ` , `— �. -: gYSTEM P � f., % MiCNACL E. ANCCRSW " .� `• � \ .��-'�� . _ AREA C ON \ SCALE 1" =100' T 31 •323 sq.f A _J 'Trees 1 44sq ppSt1NG .. w . 0 • .iL'£9 3"60.0Z.£0 5 `6� pSt�1e1 'IMS3 '3 V _1 .01 _ p0 Proposed / T Well / A ® u o O to u 1 N 4 1 u1OI, x 1 " 48.5' 1 Fa 1 Five 44.6' 1 room 1 1 ! e e 1 ai1,500 Gallo ofdP Septic Tank 35'. wN :{ 1 1 TH2O {� �1 r 1" JAS 70 I ii+ l X 81 Absoi 1 Alternate Site 1 Till i 1 1 edo 1 1 1 1 1 10' T. do E MT. T. u N 00.08'59"W 116.34' SITE PLAN SCALE 1" = 40' 3 X 3' Wide ctive Dep kL57• 49th4 M MICHAEL E. ANDERSON V LOT 219 AUTUMN RIDGE SUBDIVISION DESIGN FACTORS: Five Bedroom Home Pere. Rate: 6-35 MinAnch Avg. Application Rate: .7 GPDISF SYSTEM REQUIREMENTS: Deep Trench System 1,500 Gallon Septic Tank 8' Drain Field Rock 5 Bedrooms X 150 GPD 1.7 GPD/SF = 1,071.4 SF of Absorption Area 1,071.4 SF/16 SFILF = 66.9 LF Trench Length Therefore: Oversize the Trench From Design Requirements. Construct an Absorption Trench 70' in Length by 3' Wide With 8' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing Ground . Total Depth of Trench to Be' 11' Below Existing Surface. Cover Over Septic Tank a Minimum of 4' or 2" of Insulation and 2' of Cover. Natural 266'; 1 1 Backfill 6" ®MOVEM 3' Geotextile Fabric 40) eld Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells In the Area. Minimum 10' Separation From Water Service Line. 3 49th MICHAEL E. ANDERSON No. CE -4381 f 0 - o Municipality of Anchorage Department of Health 8 Human Services 0 �: u'aAu E. A xeson NO. CE -4381 825 L Street, Anchorage, AK 995024)650 SOILS LOG - PERCOLATION TEST ��i,� PROrEss�:•�• Performed For. Bob Klein Date Performed: 12/2/99 'Legal Description: t of 21 _ Autumn Ridge S1 rtuiivision SLOPE SITE PLAN 11 I OG/PT 4 6 SWGM 7 8 Gross Time Net Time Depth To Net Water Drop 1 6 -Dec Was Groundwater 9 4- Encountered? No . 12:12 30 If Yes, What Depth? 10 12:14 Depth to Water 4- 4 After Monitoring None 11 9" 5' . Date: 1/22/00 t2 4- Reading Date Gross Time Net Time Depth To Net Water Drop 1 6 -Dec 11:42 4- 2 12:12 30 9" 5" 3 12:14 4- 4 12:44 30 9" 5' . 5 12:45 4- 6 1:15 30 9' 5" Hole 19 Pero. Rate: 6 Min./Inch .. Perc. Hole Diameter. 6" Test Run Between 4 FL and 5 Ft. ' Comments: Percolation Cavity Presoaked Prior to Testing. _ Performed By: gale- I,Micha ISE- Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date:: 1120100 1. Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502 -OM SOILS LOG - PERCOLATION TEST Performed For. Bob Klein Date Performed: c,�... Legal Description: 1 of 1 Autumn RgjgP � rv��ion _ SLOPE SITE PLAN 1� OG1PT n iii 6. SM n th.._.. ,.6 r r 4 C.Z C. ANDERSON �!�.•'t, No. CE -4381 J 1212199 3 Dry ®®��' Was Groundwater .. Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Date: 1122100 Dry ®®��' l .. • �' Sr �Nmm® Hole 19 Perc. Rate: 35 MinAnch Perc. Hole Diameter. 6', Test Run Between 4 Ft. and 5 FL Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: A. Hafal'1 I, Michael F Anderson Certify That This Test Was Performed In Accordance With All Stale and Municipal Guidelines In Effect On This Date: 1120!00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 21, AUTUMN RIDGE SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,500 -gallon septic tank at the location shown on the site plan and the construction of a new 70' long by 3' wide by 8' effective depth absorption trench also shown on the Site Plan. The total depth of the trench will be 11' below existing ground and the distribution pipe will be placed at 3' below the surface. All components of the new absorption trench and septic tank must be constructed a minimum of 100' from wells in the area and 100' from any surface water. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,500 -gallon septic tank must be procured from a certified septic tank manufacturer. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. Lot 21, Autumn Ridge October 28, 2002 Page 2 of 2 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. Lot 21, Autumn Ridge October 28, 2002 Page 3 of 3 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Braga~ St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING IJIN Parcel I.D. 055 4-24 1. GENERAL INFORMATION HAA# hZC�2 SSG Expiration Date: i 0 - - 0 3 Complete legal description I of 2.t Autumn KW4Q 6ubdlvl ton Location (site address or directions) 71P 'a k Circla Current Property owner(s) crown pointe -7-R157'� Mailing address Lending agency Mailing address Real Estate Agent Mailing Address unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: individual Well Individual Water Storage Community Class Well Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL~ ® Individual On-site Individual Holding tank ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water are supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Ane .rFon nalneeriny Phone _522-7773 Address P.O. Box 240773 An .horanrAK AA524 Engineer's Printed Name-ltchael F. Ane rson r Date __ 5/25/2003 y MICHAEL E ANIDt�I 5. DSD SIGNATURE y i'•.,L No. cEr3el .r Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: NAA Checklist x Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 7-1—o3 4� Municipality of Anchorage ,• Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 190850 Anchorage, AK 99519.8850 www.ci.anchorage.ak.us (907) U3-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: tet 21 Autumn Rldua Subdivision Parcel ID: -215-05424 A. WELL DATA Well type Pdli s Date completed 11110 002 Total depth eft. Date of test Static water level Well production g.p.m. If A. B, or C provide PWSID # _ Sanitary seal (YIN) Y Cased to eft. FROM WELL LOG 11f1012002 36 ft. 10 WATER SAMPLE RESULTS: Coliform -�L-colonieslto0 ml. Nitrate 2.65 mg./l. Date of sample: 612312003 Collected by: MFA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SeWdIAM Tank size 1.500 gal. Number of Compartments j Foundation cleanout (Y".Y Depression over tank (Y/N) b Date of pumping C. ABSORPTION FIELD DATA Weil Log MN) Y Wires properly protected (Y/1) Y Casing height (above ground) min. AT INSPECTION ft. Other bacteria _j_ oolontes/100 mi. Date installed 11812002 Cieanouts (YM) High water alarm (YIN) N Date installed 111=02 Soil rating (g.p.d./fe or fe/bdrn) .7 GPDISF System type DOD Trench Length 70 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth n ft. Eft. absorption area 1.120 fe Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fall) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ In. Absorption rate >= 9-P.d. Any rejuvenation treatment (past 12 moa (YIN & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Aooess (YIN) 'Pump on' level at _ in. •Pump off" level at _ in. High water alarm level at Datum Cycles tested Meets alarm & circuli r uirem t 7 eqen s E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 3,100 On adjacent lots 3,100' Absorption field on lot 3,100' On adjacent lots 3,100' Public sewer main WA Public sewer manhoWcleanout WA Sewer /septic service line _3,1.5 Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3,5 Property Ane 3,Z Absorption field_a Water main WA Water service line 3,101 Surface water >,IIV Wells on adjacent lots 3,100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3,10 Building foundation 3,10' Water main 3,10' Water Service line >10' Surface water _3,100' Driveway, parking/vehicle storage 3,40' Curtain drain None Noted Wells on adjacent lots 3,100' F. COMMENTS G. ENGINEER'S CERTIFICATION 4-0, rCvF7 ,gyp,'.,.............. I certify that I have determined Mro ugh flefd inspections and =+r review of Municipal records that the shove systems are hn 4 h confbrmance with MOA HAA guidelines in effect on this data.COMM T Engineer's Printed NameMichael E Andenon P E ` c �tmntsol No. etwa i Nr Date 60I2003 HAA Fee $ -3-7S- Date %5Date of Payment L— 2 3 o 7 Receipt Number 37 f $ j S v (Rev. 12(00) Waiver Fee $ Date of Payment Receipt Number, in. 6-27-03;10:20AM; SGS ReLB 1033685001 Client Name Anderson Engineering ProjectName/x Lot 21 Autumn Ridge Client Sample ID Lot 21 Autumn Ridge Matrix DrinIcing Water Sample Remarks: ;907 5615301 All DatesMmes are Alaska Standard Time Printed Date/time 06/26/2003 14:07 Collected DateMme 06/23/2003 14:00 Received Date/time 06/23/2003 1423 Technical Director St�C.Ede Relns��✓ r 2/ 3 Allowable Prep Analysis parameter Qualifiers Results PQL Units Method Container ID Limits Date Date Inst Waters Department Nitrate -N 2.65 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA300.0 B (<`•10) 0623/03 JJB coV100mL SM18922213 A (G=1) 0623/03 KAP :907 5615301 0 3/ 3 6-27-03;10:20AM: . ME Environmental Services Inc.. 10 Laboratory Division �rrr®atar�%t�,a�®vstlr�®af'rr''taerrzc'i.�''rur�ssa"®saar�+s�•eogr 200 W. Potter Drive )rinl&g Water Analysis Report for Total Coliform Bacteria Teaehor.° AKS9618-1605 Tel: r E S E E ORE COLLECTING SAMPLE ' Fax BEAD INSTRUCTIONS ONREYEID FRS $ T^ 1. TO BE COMPL�I7 E .. o PUBLIC WATER SYSTEM I.D. S o PRIVATE WATER SYSTEM O SaldResnfu O Sendfaroice YY yYYa . as e a OM Y U v o s GIewlrJ R, 04 Send/evoke SAMPLE DATE: , Month Day Year SAMPLE TYPE: Routine o Repeat Sample (for routine sample withlab reGno. p -Special Purpose SAMPLE LOCATION 1 >' ZI Lnur P ' TLcIo Comments: O Treated Water Untreated Water Time Collected Collected By rkas Prim Analysis shows 199 Water SAMPLE to be: Satisfactory p Unsatisfactory O Sample over 30 bouts old, results may be unrcllablc 0 Sample too long in tausit; sample should not be oven Vhours old at examination to indicate reliable results. Please send new sample via special -::2-�l -o S. il. D2teReceive'd lSS Time Received Gu 2 An Began 1-1 w Analytical Method: ��ai�cilter 1 . • . , ,. _01 mi. ' 1033685 tesult• Analyst All .111111 fd,Zs,� b ' Aent to A.u•t:.C. Meh FDW Jun Fazed Date: Time: Client notified of unsatisfactory results:, Phoned Spoke with razed Date: T=w. BACTERIOLOGICAL NVATER ANALY�SI1S RECORD I . 4 S lu�E, cou pih/l0•MUG Result: Total Coliform Colonies/100 0Membrane Filter.. Direct Count Verification: LTB BGB COLIFIRNI Fecal Coliform Confirmation C011formiloo MI Fin2l Membrane Filter Results Time brs Reported By atO TNTC- ra. NYa,Mer rs GYar Oa-01h<VdVMe IfUtSES Member Of the SGS Group (SocidtdGdndraledeSurveillance) _ MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. 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